At the Heart of Community-Engaged Research in Halifax County, N.C.
The research teams at North Carolina Central University (NCCU) have placed an emphasis on trust, partnership, and mentoring in their efforts to understand and reduce health disparities in Halifax County, N.C. To achieve this goal, K. Sean Kimbro, Ph.D., one of the lead PIs of NCCU’s RCMI-Center for Health Disparities (RCHDR) Community Engagement Core (CEC), helped develop the CEC’s Research with Care initiative. The initiative established a holistic framework to develop community-engaged research projects between NCCU investigators, students, and residents of Halifax County.
Halifax is a rural county in the northeast of N.C. and over seven hundred square miles in area. Many of the communities there experience higher rates of poverty, housing cost, food insecurity, and unemployment, and have access to fewer primary care and mental health professionals, compared with the average of the state. In particular, the prevalence of type 2 diabetes (T2D) in the county is twice the state average.
“Transportation is the number one issue for our county,” Ms. Gerald says. “Some people have to drive thirty miles to get food. We have always been a family farming community, which is ironic because now that farming has become primarily a business in the county, it’s hard to get fresh food.”
Ms. Ruby Gerald, Halifax County resident
In 2012, Dr. Kimbro wanted to better understand the influencing factors that contribute to T2D in Halifax County. NCCU had been awarded an NIMHD-funded P20 center grant and he collaborated with the lead-investigator of the Diabetes Family Project (DFP), Natasha Greene, Ph.D., F.N.P., R.N., which was a part of the grant. “During the project,” he says, “we worked with local churches to educate individuals with diabetes on diet, exercise, and healthy eating behaviors. Importantly, we also trained family members on how to manage diabetes to change the home environment and behaviors to improve diabetes management.”
NCCU is an Historically Black College or University (HBCU) and Dr. Kimbro knew that being part of an institution that contributes to the training of African American researchers and clinicians could be a welcoming factor in establishing ties in the county, where over half the residents are African American. “There’s nothing more magical than an African American investigator at an HBCU going out in the community and bringing NCCU students with them to learn,” he says. The DFP ran until 2017 and trained over 50 NCCU students on how to go out into the communities of Halifax County to learn about the health experiences of the people living there, develop new relationships, and conduct research surveys.
In particular, NCCU nursing students worked and trained with community members – asking them to share their daily experiences, taking time to listen, offering opportunities to participate in research, and collecting blood and urine samples. “Even to this day,” Dr. Kimbro says, “people come up to me and say, ‘I remember the Diabetes Family Project!’”. It became a powerful example of how to collaborate in the African American community.
The Power of Trust with the Community
Projects like the DFP helped show the community that NCCU was interested and supportive of long-term partnerships to improve the health of those living in Halifax County. To do that, another component of their work was to train community health educators to help coordinate event activities and research discussions between NCCU and the community.
Members of the P20 CEC recruited Ms. Ruby Gerald while she was working for the Halifax County Chamber of Commerce. She was born in the county and knew the area and its people very well. One of her roles in government was to get to know the communities as much as possible to better assist their needs. “Transportation is the number one issue for our county,” Ms. Gerald says. “Some people have to drive thirty miles to get food. We have always been a family farming community, which is ironic because now that farming has become primarily a business in the county, it’s hard to get fresh food.”
Food accessibility and insecurity are risk factors for T2D. Ms. Gerald wanted to leverage her connections to help the people she worked with daily. She trained with NCCU researchers to be one of the community health educators. “Central was doing work in diabetes,” Ms. Gerald says. “I have family with diabetes, and it was important to me. I worked with other partners, including Black churches, to encourage people to be receptive and talk to someone they could trust.”
She helped facilitate introductions between NCCU investigators and community members and organizations to discuss possible research projects. Those earlier relationships have helped establish NCCU as an important voice in Halifax County. Today, Ms. Gerald also works with Dr. Lorraine Taylor, Ph.D., Executive Director of NCCU’s Juvenile Justice Institute and co-lead of the RCHDR CEC.
Dr. Taylor supports training new faculty at NCCU on how to conduct community-engaged research. “The enthusiasm for community based participatory research doesn’t mean you know how to do it right,” she says. Together with Ms. Gerald and the CEC, they mentor investigators on best practices for community-engaged research. NCCU now has several ongoing community projects, including with Halifax County public schools, churches, and the Halifax County Health Department, among others.
“We have to leverage opportunity and connections where we can,” Dr. Taylor says. She helps NCCU students develop and organize pamphlets and other materials on health topics relevant to those living in Halifax County, including glaucoma, autism, and sexually transmitted diseases. “Central puts together newsletters on a series of health conditions that I circulate through agencies in the county,” Ms. Gerald says. Then, she shares with Dr. Taylor the impact of them.
The newsletters have helped individuals have important health conversations with their doctors or garnered further interest in meeting with NCCU researchers to discuss health disparities research. NCCU faculty and students have also been critical in the response to COVID-19 in Halifax County during the pandemic.
The model has been so successful, that Drs. Taylor and Kimbro, and Ms. Gerald, published a paper on how HBCU’s can engage with rural communities, highlighting the need for long-term partnerships and trust between the local community and research institutes.
Training the Whole Scientist
Dr. Kimbro has been doing laboratory research since he was sixteen years old. “I’m a descendant of enslaved people and a product of the sacrifices of my ancestors,” he says. As an experienced research investigator, he understands the impact of going out into the community and being seen, and how important that is for students to learn from and grow with the community.
In his laboratory, he emphasizes skill building both in community engagement and basic laboratory knowledge. “The power of having a student conduct the study in the community is huge,” he says. “The idea is to get students in biology labs out doing community service and taking behavioral students and bringing them into the lab to get an appreciation for the laboratory side of research.”
Ezekiel Wamble, B.S., is a third-year Ph.D. candidate in Dr. Kimbro’s lab. He was attracted to the opportunity not only to work with community members, but also on how to analyze the samples he was collecting. He participated in one of the NCCU trips organized by Dr. Taylor and Ms. Gerald into the county. “I remember driving around Halifax County and realizing one of the only sources of foods was a Dollar General,” he says “I wondered, where’s the produce? This is all processed foods.”
Ezekiel met with community members to talk about their health needs, including issues related to T2D. His doctoral research project continues prior work from the Kimbro Lab that identified elevated levels of pro-inflammatory cytokines in African American women with obesity and high HbA1c – a diagnostic marker of T2D. His current training at the bench will allow him to work with the samples he collects from the community and better understand the societal and structural factors contributing to inflammation and T2D disparities in Halifax County. “I want to be out there for people and to help them,” he says.
Dr. Kimbro also provides mentorship to help students understand the historical and structural barriers within the county region. Recently, he and members of his laboratory visited the Tillery History House in Tillery, N.C. to honor the ancestors of the site (see photo below). The Tillery History House was an experimental farm resettlement from Franklin D. Roosevelt’s New Deal Resettlement Program. The purpose of the farm, and others like it, was to give African American families the opportunity to purchase and own land. The Tillery Farms Project helped establish Black wealth in the area and contributed to empowering community members to challenge racial injustices.
This perspective has aided NCCU investigators in developing new projects to address local disparities. “Understanding the history of Halifax County can help identify the structural barriers still contributing to some of the disparities present,” Dr. Kimbro says. “This is how we stay relevant.”
There is a lot of work left to be done, but the trusted relationships that have been established between NCCU and residents in Halifax County offer many opportunities to continue improving the health of those in the region.
Page updated November 11, 2021